Risk of repetition and subsequent self-harm following presentation to hospital with suicidal ideation: A longitudinal registry study

Abstract

Background: Few studies have focused on those who present to hospital with suicidal thoughts (suicidal ideation). The aim of this study was to establish the risk of repeat presentation to hospital following suicidal ideation and to identify factors which were associated with further ideation or subsequent self-harm. Methods: Data were obtained from the Northern Ireland Registry of Self-harm. Risk of repeat presentation following hospital-presenting ideation was analysed using Kaplan Meier analyses, specifically cox proportional hazard models. Findings: During the period April 2014 to March 2019, a total of 14,695 presentations to hospital due to suicidal ideation were made in Northern Ireland. The cumulative incidence of repeat presentation to hospital was 40¢5% within five years, with an 18¢3% risk of subsequent self-harm. Previous ideation had the strongest association with repeat presentation. There was evidence of recidivism considering further ideation, with an increased risk according to number of previous presentations. In contrast, risk of subsequent self-harm was highest after the first or second presentation. Male gender and alcohol were associated with further ideation, while females and young people were more likely to re-present with self-harm. Interpretation: The findings indicate that individuals who present to hospital with suicidal ideation are at risk of repeat presentation and future self-harm, however clinical guidelines do not specifically address hospitalpresenting ideation. The transition from ideation to suicidal behaviour is important to consider and research could inform effective screening and early intervention measures. Role of Funding: The Northern Ireland Registry of Self-harm is funded by the Public Health Agency, Northern Ireland.

Predicting risk along the suicidality continuum: A longitudinal, nationally representative study of the Irish population during the COVID‐19 pandemic

“…Our findings, therefore, are consistent with and complement those from studies that have investigated the association between these phenomena over time (Mars et al, 2019 ; Neeleman et al, 2004 ; Ribeiro et al, 2016 ). Based on these data and recognizing that (a) suicidal ideation is one of the strongest predictors of psychiatric hospitalization and death by suicide (Klonsky et al, 2013 ), and (b) that individuals who present to hospital with suicidal ideation are at risk of repeat presentation and future self‐harm (Griffin, Kavalidou, Bonner, O’Hagan, & Corcoran 2020 ), early interventions that target and treat suicidal ideation are likely to be beneficial in preventing suicide‐related behaviors. Existing psychotherapies such as Dialectical Behavior Therapy (Geddes et al, 2013 ) and Cognitive‐Behavior Therapy (Tarrier et al, 2008 ) have been shown to be effective in reducing suicidal thoughts.…”

Suicidal thinking as a valuable clinical endpoint

“…Considerably more research on suicide is needed in many areas so it would be impossible to identify all of the places where we should focus our attention. Given this, I conclude this commentary by highlighting two (of potentially many) themes for future research that build off of work done by Griffin et al [1] and others who have studied suicide thinking. First, it is important to explore suicidal thinking in settings beyond the hospital.…”

“…In this issue, Griffin and colleagues [1] present data on repeat hospital presentations among those who visit the hospital due to suicidal thinking (also called suicidal ideation). They found that about 4 in 10 people who visited the hospital once for suicidal thinking did so again within five years.…”

Suicidality in a psychiatric inpatient unit: a 2-year retrospective study in Umbria, central Italy

“…Overall, SI represents the most important and direct risk factor for suicide, whereas the prevalence of DSH among patients who died by suicide was estimated around 58%, so DSH could be considered as a subthreshold suicidal symptom (Klonsky and May, 2010; Griffin et al ., 2020). It is estimated that 33.6% of individuals experiencing suicidal thoughts would subsequently develop a suicidal plan, and 56% of those with a plan would attempt suicide (Littlewood et al ., 2017).…”